Delusions, paranoia, and other symptoms of mental illness plagued Melanie, a 25-year-old Appleton woman, before the Outagamie County Circuit Court found probable cause to commit her involuntarily for outpatient treatment and medication.

The circuit court concluded, after hearing evaluations from doctors, that she was incompetent to refuse medication. Although Melanie agreed to be medicated for six months, the county petitioned for an extension for another year.

Doctors prescribed Seroquel and Lorazepam for anxiety, as well as Celexa, an anti-depressant. But Melanie stopped taking Celexa. At extension hearings, the county again argued that Melanie was incompetent to refuse medication and treatment.

Under Wis. Stat. section 51.61(1)(g)(4), a person can be incompetent to refuse medication if “the individual is substantially incapable of applying an understanding of the advantages, disadvantages and alternatives to his or her mental illness … in order to make an informed choice as to whether to accept or refuse medication or treatment.”

The circuit court ordered Melanie to keep taking prescribed drugs under the outpatient treatment plan for another year, noting the county met its burden by “clear greater weight of the evidence.” Melanie appealed. She said the county failed to meet its burden to prove that she was incompetent to refuse medication.

First, the majority said the circuit court misstated the burden of proof as “clear greater weight of the evidence.” Second, it ruled the county did not meet its burden.

“[W]e apply the facts of Melanie’s case to the statute and conclude that the County failed to prove by clear and convincing evidence that Melanie was incompetent to refuse medication,” wrote Justice David Prosser for the majority.

The majority said a request to force medication on an individual triggers significant liberty interests, and a person is presumed competent and can refuse medication unless the state proves the person’s incompetence, by clear and convincing evidence.

“This is a difficult standard for a county to meet if the individual is able to express a reasonable understanding of the medication,” explained Justice Prosser, noting that Melanie expressed an understanding of the pros and cons of the medication.

The majority ruled that the county failed to rebut a presumption of competence by proving Melanie could not apply her understanding of the drugs to her own situation.

That is, the majority said the county failed to prove, by clear and convincing evidence, that Melanie was “substantially incapable of applying” her understanding of the drugs to her own mental illness in order to decide if she should take them or not.

“[T]he result might have been different if the County had produced additional evidence in terms of additional witnesses or additional detail,” wrote Justice Prosser, noting that experts “must apply the competency standards set out in the competency statute.”

Dissent

Justice Annette Ziegler, joined by Justices Michael Gableman and Patience Roggensack, concluded that the county’s evidence was sufficient to support an involuntary medication order, and the majority should have deferred to the circuit court.

“In this case, the circuit court was satisfied by clear and convincing evidence that Melanie was incompetent to refuse medication,” Justice Ziegler wrote.

The dissent argued that the majority’s opinion creates “a substantial hurdle for counties to clear” before individuals who pose a danger to themselves or others can be involuntarily medicated, meaning counties will be unable to treat those persons.